Detection can happen anywhere, particularly in community settings like the bank, coffee shop, or pharmacy. For instance, a pharmacist may notice behavioral changes in a person while they are picking up medication. Screening is the logical next step after detection. If the pharmacist has strong rapport with a person who is experiencing cognitive or behavioral changes, they can mention what they see to that person or someone with them (friend or family member), to encourage them to follow up with cognitive assessment. Diagnosis requires a health care professional’s evaluation. A positive dementia screening result should lead to diagnostic consultation. Some people may be referred to a specialist, but primary care providers can do the diagnostic workup.

Screeners or screening tools are used to predict the likelihood of cognitive impairment. Screening tools can detect early changes in cognitive functioning, and can also be used to monitor changes in cognitive functioning over time. There are two types of screening tools:

• Performance-based screening tools are administered to patients. Examples of performance-based screening tools include:
  • Mini-Cog
  • Saint Louis University Mental Status Examination (SLUMS)
• Function-based screening tools are administered to informants (e.g., care partner, family member, close friend)
  • 8-Item Informant Interview (AD8)
  • Quick Dementia Rating System (QDRS)
  • Functional Activities Questionnaire (FAQ)

Both have value and are often used in combination. Other tests may be recommended to look for possible contributing factors once a problem is detected.

Administration of screening tools is not limited to health care professionals. Many screeners can be administered by any individual who has completed training specific to a screening tool. The training requirements and resources vary from screener to screener. Some are very short and simple.

Undetected dementia can lead to adverse health outcomes. Detecting dementia earlier can lessen the occurrence of:

• Missed medical problems
• Avoidable accidents and injuries
• Medication errors
• Caregiver stress
• Family conflict
• Poor chronic disease control
• Wrong treatment
• Post-surgical complications
• Poor continuity of care
• Delirium
• Preventable emergency visits, hospitalizations, complications, and readmissions

The “best” screening tool is the one that works best in your setting, with your capacity and programmatic goals. The screening tools listed in our toolkit have been tested and validated in a variety of settings and among different communities. You may start by adopting one tool and later add or change to another as needs evolve.

Refer to our overview of screening tools.